Suffering #2 Suffering, death, and grief

Suffering #2 Suffering, death, and grief are deeply intertwined human experiences, with the death of a person often causing the most profound changes in the lives of those left behind. Elizabeth Kübler-Ross, a Swiss-American psychiatrist and a pioneer in near-death studies, brought global attention to these processes through her internationally best-selling 1969 book On Death and Dying. In it, she introduced what became known as the Kübler-Ross model—the five stages of grief—originally developed to describe the emotional process that patients with terminal illnesses go through as they come to terms with their own deaths. Later, this model was applied to grieving friends and family members, who often seem to undergo a similar emotional journey. Contemporary bereavement research confirms that while these stages are not experienced in a fixed order and not everyone experiences all of them, the framework still provides a valuable lens for understanding grief’s psychological complexity.

According to the Kübler-Ross model, individuals experiencing grief may pass through five emotional stages: denial, anger, bargaining, depression, and acceptance.

Denial is the first reaction, where individuals believe that a diagnosis or reality is mistaken, clinging to a more comforting but false version of events. Some may isolate themselves from others who have accepted what is happening. This is often a temporary defense mechanism, providing emotional cushioning until the mind is better prepared to process the truth. Neurocognitive studies suggest that denial involves reduced activation in brain areas responsible for threat detection, allowing individuals temporary relief from overwhelming stress.

Anger arises when denial can no longer be maintained. Frustration may be directed toward loved ones, medical staff, or even fate itself, with questions like “Why me? It’s not fair.” Kübler-Ross emphasized that allowing individuals in this stage to fully feel their anger without taking it personally is essential. From a physiological perspective, anger in grief is linked to heightened sympathetic nervous system activity, increasing heart rate, blood pressure, and stress hormone release, which can, over prolonged periods, impact cardiovascular health.

Bargaining involves attempts to negotiate for more time or a reversal of loss, often through promises of personal change. This may take spiritual forms—such as making deals with God—or practical ones, such as lifestyle changes in exchange for hoped-for recovery. Psychological research connects bargaining to the brain’s problem-solving circuitry, as the mind struggles to regain a sense of control in a situation that feels uncontrollable.

Depression in grief is marked by profound sadness, withdrawal, and a sense of hopelessness. The grieving person may lose interest in daily activities and isolate themselves. Kübler-Ross observed that this stage often reflects a confrontation with the finality of loss. Clinical evidence shows that this state can overlap with major depressive episodes, characterized by changes in neurotransmitter levels—particularly serotonin and dopamine—that regulate mood, motivation, and pleasure.

Acceptance is the final stage, marked by a calm acknowledgment of mortality or the inevitability of loss. This does not mean happiness, but rather a stable emotional state that allows the person to reflect on the past and prepare for the future. Modern grief studies highlight that acceptance is associated with increased activity in brain regions involved in emotional regulation, such as the ventromedial prefrontal cortex, allowing individuals to integrate the reality of loss without being emotionally destabilized by it.

While Kübler-Ross’s work remains influential, contemporary grief science recognizes that grief is highly individual—some people cycle through these emotions repeatedly, others skip stages entirely. Importantly, modern research on bereavement emphasizes that the capacity to adapt after loss depends not only on internal psychological processes but also on social support, cultural beliefs, and the individual’s resilience, which can be shaped by both genetics and life experience.